Running head: VETERANS’ HEALTH ADMINISTATION 1
Veterans’ Health Administration
Group 3 Project
April Banks
David Hess
Terrance Lasher
Tara Webb
Angela Winfrey
BMAL 504 – Leading Organizational Change
March 4, 2019
VETERANS HEALTH ADMINISTATION 2
Part 1
The Veterans’ Health Administration (VHA) is the largest health care system in the
United States. Designed to provide medical care for veterans that have been honorably
discharged, it has 1,250 health care facilities, including 172 medical centers and 1,069 outpatient
sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans
each year [ CITATION Dep19 \l 1033 ].
The Public Image
In recent years the VHA has faced a crisis. Issues ranging from out-of-control infections
running through the hospitals to veterans dying from sickness, disease, and injuries while waiting
for appointments to address the issues they died from. Many had been waiting anywhere from
three to twenty-one months for an appointment that had the potential of saving their
lives [ CITATION Rod16 \l 1033 ]. The 2012 VHA guideline on performance was focused on
being “results driven;” however, the only measurable outcome was a recommendation that
patients should not wait more than fourteen days from their desired appointment
date [ CITATION DMo \l 1033 ]. The system which was once lauded as one of the best hospital
systems, is failing those that gave the most for the United States.
In addition to long wait times, many of the officials were receiving large bonuses for
performance, which was subpar at best, on top of large annual salaries. However, when looking
at the performance rate of the VHA it is clear that the performance is much lower than standards
should allow.
The Communication between the Department of Defense and the DVA is broken.
Currently, the processes for obtaining VHA benefits starts at the transition of the military
VETERANS HEALTH ADMINISTATION 3
member leaving the military and entering civilian life. This process, as it stands now, can take up
to seven years for a military member to obtain VHA access after discharge. The process of
transitioning to VHA benefits begins 30 days prior to discharge. The VA will decide of how
severe the disability if based on the evidence submitted either through military record or
submission from the claimant. The disability rates as of 2019 ranged from 0% to 100% in 10%
increments [ CITATION Dep19 \l 1033 ]. They also were based on whether there were
dependents or not. Currently, there is a backlog of claims as well as a backlog of rating requests.
The number of pending claims is nearly 368,000 that require development and decisions by
processors [ CITATION Vet19 \l 1033 ]. Claims for initial rates is backlogged at nearly 80,500
and have been pending for more than 125 days since they were initially received [ CITATION
Vet19 \l 1033 ]. On average, it takes 109 days to receive a decision on a rating claim if the
veteran used the Fully Developed Claim (FDC) process which is an online portal. If they process
the claim without the FDC, that number increases to 114 days for processing.
Part 2
Recommendations
How can the organization be fixed? “Leadership alone, cannot bring about large-scale
change. To succeed, a change effort must have broad based support throughout the organization”
[CITATION Jic11 \p 116 \l 1033 ]. The employees of the VHA do not go to work every day to
fail, they go to provide the Veterans of the United States with the care that they need and deserve.
However due to logistics and red tape, it makes it difficult for them to do their jobs and get those
that need help in as quickly as they should be. In order to make the change, organizational
changes need to be made. As Jick and Peiperl mention, the organizational capabilities need to be
reviewed and changed. Similarly, the capabilities of the individuals within the organization need
VETERANS HEALTH ADMINISTATION 4
to be reviewed. Likewise, any changes made need to be shared clearly and consistently with
everyone in the organization. The vision and mission need to meet the goals that the organization
desires and a framework needs to be put in place in order for them to be successful [ CITATION
Anð17 \l 1033 ].
Organizational change is the process that adjusts the organization to the changes in the
operating environment [ CITATION Sat18 \l 1033 ]. While organizational change causes
growing pains, everything that falls within the wake of those changes will need to be assessed
regularly. One of the changes that has already been made is the allowance of private doctors for
Veterans that live outside the service area for VHA hospitals [ CITATION Har13 \l 1033 ]. By
outsourcing its health care to private providers, it will allow for more veterans to get quality care
while easing the backlog of those waiting for appointments. It also allows for those that live
outside a VHA service area to obtain medical services needed without having to pay out-of-
pocket expenses.
The logistics of this change however are challenging. Currently, veterans can move
between facilities and locals seamlessly due to the implementation of the electronic patient
records keeping system the VHA utilizes. The Computerized Patient Record System (CPRS) sets
a higher standard for patient record keeping that what is currently being used in private medical
practice, though it has been studied and is under review for private practice. The logistics of
connecting private practice networks to government networks for full access to CPRS will
present security requirements that are currently not needed [ CITATION Kiz09 \l 1033 ]. There
will need to be a way to seamlessly transition to other facilities nationwide should a veteran
relocate. However, the need to provide timely and proper care for veterans far outweighs the
issues surrounding the management of patient records.
VETERANS HEALTH ADMINISTATION 5
Definition of Project
The VHA needs to undertake the challenge of changing their image as well as the
perception of the VHA. The idea that staff puts their own welfare and comfort ahead of that of
the veterans is an obstacle that will need to be overcome. Changes will need to be immediately
made and as performance increases and needs are addressed, public perception will improve as
well. Some changes have already begun to be implemented.
Beginning in 2014, the leadership of the VHA changed with the Secretary of Veterans’
Affairs being removed from that position as well as several others in leadership. This was a result
of those leaders being more focused on the numbers than on the veterans. Data was skewed and
which allowed poor performers to stay qualified for performance bonuses. All while veterans
were dying while waiting to see a doctor for basic health care. Ultimately it was these types of
situations that led to the investigation and subsequent removal of individuals in authority.
Diagnosis of situation
As a part of the attempt to change the organization, the Veterans Access, Choice, and
Accountability Act of 2014 was approved by Congress. This program allowed veterans to have
access to better, privatized care, specifically for short-term medical needs [ CITATION Har13 \l
1033 ]. On its face, this was a great idea. The problem with the plan was that if the veteran did
not get preapproval, they would end up paying out-of-pocket for the medical services received.
This could end up running into the tens-of-thousands that the veteran is responsible for, adding to
the stress the veteran may already be experiencing.
Leadership also has the appearance of being more interested in meeting their own needs
rather than those of the veteran. While leadership at the top has changed, there is still suspicion
VETERANS HEALTH ADMINISTATION 6
that the new leadership won’t be any different. In 2015 Mr. McDonald who had been nominated
to the position of Secretary of Veterans Affairs, apologized for lying about his alleged Special
Forces service. This reinforced to the public that the leadership of the VHA had not changed, just
the faces changed. The culture was still the same.
Recommendations
In reviewing the circumstances, it would be prudent to have an independent committee
to oversee and administer the management of those veterans currently partaking of the VHA’s
services. The committee should be transparent in its management and there should be a way for
the public to access communication with the committee in the event that there is a situation that
needs immediate attention. The committee would report directly to the Secretary of Veterans’
Affairs and a report made that would be directed to the President of all actions taken to mitigate
the current healthcare situation.
Additionally, the requirement for preapproval should be removed or streamlined so that
in the event a Veteran obtains medical services from an outside provider, they are not responsible
for the bill. This would act in a similar fashion to private healthcare and in-network or in-kind
network services. If a Veteran is authorized to use the Veterans Access, Choice, and
Accountability Act of 2014 they should not have their health hindered further by a cumbersome
preapproval process. At most a copay, if required at the VA hospital, would be required by a
private healthcare provider.
Finally, a full audit, conducted by an independent auditor or audit shop should be
conducted on the VHA’s processes and procedures to ensure that the most efficient system was
being put in place. This audit would include the appointment and approval system as well as
VETERANS HEALTH ADMINISTATION 7
looking at the staffing to ensure that veterans had the best system in place for their medical
needs.
Implementation Plan
While the initial implementation would require tremendous oversight from the Secretary
of Veterans’ Affairs, once the changes were made and systems running well, Congress would
appoint the independent committee who would have full and direct access to all enrollment
records, appointments – both requested and in process – as well as the backlog of those that were
awaiting approval for the rate. The committee will also be given full access to outsourced
services.
Operational procedures and processes should be streamlined in order to reduce costs as
well as eliminate any redundant operations. It may be prudent as well to eliminate the
performance bonus for employees until the veterans are cared for and the changes are fully
implemented. The veterans should be the first priority of the employees, including those in
management.
Summary
Health care for the United States Veteran should always be available to them. Quality
health care should not be something that these men and women, who have served honorably and
who have given up so much, have to worry about. The cost of administering healthcare for them
should not be put on them, but on those that have the ability to change it. Costs to their care can
be reduced by streamlining the processes and procedures, putting better systems in place, and
leadership taking a proactive, caring approach to how they handle the administration of the VHA
as a whole. The administration should take the view that until Veterans receive healthcare in a
VETERANS HEALTH ADMINISTATION 8
timely and consistent manner, then monetary awards to the employees that are failing the
veterans should not be given.
The care, concern, and empathy for veterans should be felt by all those that benefit from
their sacrifice. While the suggested changes will take work to implement, in the long run, the
changes will curb the current backlog and shortfalls within the VHA. The veterans that rely on
the VHA for their health deserve to be seen in a timely fashion with as much care and honor that
they gave while serving.
VETERANS HEALTH ADMINISTATION 9
References
Anðelić, S., Nikolić, M., & Vesić, T. (2017, April-June). Strategic adjustment of the company
changes. Ekonomika, 63(2), 87-95. doi:doi:10.5937/ekonomika1702087A
Department of Veterans' Affairs. (2019). Providing health care for veterans. Retrieved from
Veterans' Affairs: https://www.va.gov/health
Jick, T. D., & Peiperl, M. A. (2011). Yingscape and Yangsearch. In T. D. Jick, & M. A. Peiperl,
Managing change: Cases and concepts (3rd ed., pp. 112-113). New York, NY: McGraw-
Hill Irwin.
Kizer, K., & Dudley, R. (2009). Extreme makeover: Transformation of the Veterans' Health Care
system. Annual Review of Public Health, 313-339.
doi:10.11.1146/annurev.publhealth.29.020907.090940
Moynihan, D. (2014). The problem at the VA: 'Performance perversity'. The LA Times. Retrieved
February 16, 2019, from https://www.latimes.com/opinion/op-ed/la-oe-moynihan-va-
scandal-performance-perversity-20140602-story.html
Rodriguez, A., & Brown, A. (2016, February). Conceptualizing leadership psychosis: The
Department of Veterans Affairs scandal. International Journal of Public Leadership,
12(1), 14-31.
Rogers, H. (2013, October 2). H.R.3230 - Veterans Access, Choice, and Accountability Act of
2014. Retrieved March 4, 2019, from Congress.Gov:
https://www.congress.gov/bill/113th-congress/house-bill/3230
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Satterlee, A. (2018). Organizational management and leadership. Raleigh, NC: Synergistics
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Veterans' Affairs. (2019). Veterans Benefits Administration Reports. Retrieved March 4, 2019,
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